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Biomedical subjects

J Shime

Publications and source records attributed to J Shime.

At least 19 recordsLinked to original sources
PubMed2001

Prophylactic oophorectomy in Ontario.

OBJECTIVE: To determine the indications, patterns of practice, and complication rates for prophylactic oophorectomy in Ontario. METHODS: From hospital discharge abstracts, 82 hospitals were identified where at least one patient had a prophylactic oophorectomy since 1992. Ethics approval for the chart review was obtained from 41 hospitals (50%), was denied at 10 (12%) and is pending at 31 facilities. Using the International Classification of Disease diagnostic code for family history of ovarian cancer (V16.4) and prophylactic oophorectomy (V50.42), the medical records departments were asked to retrieve the charts. One abstractor reviewed the charts using a standard form to collect demographic information, indications for surgery, details of surgery and complications. RESULTS: From 1992-1998, 263 women underwent PO in 41 hospitals. A BRCA1 or BRCA2 mutation was recorded in 16 cases. Thirty-six patients had a past history of breast cancer. In 127 women, a family history was the sole reason for surgery; the remaining 136 women had a coexisting gynecologic complaint. Laparotomy was used exclusively in 155 cases, laparoscopy in 79 and vaginal access in 12 cases. Seventeen women required conversion to laparotomy during the operation. The mean length of hospital stay was 3.7 days (0-14 days). Thirty-six women (14%) had complications. CONCLUSION: We have described the indications for surgery, trends in surgical practice and surgical complications for women receiving prophylactic oophorectomy in Ontario. Prior to prophylactic oophorectomy, the indications and benefits should be clear to both patient and physician. Optimally, all women should receive genetic counseling to help define risk for ovarian and breast cancer, medical and surgical options, impact of oophorectomy on cancer risk, risk of surgical complications, and the consequences and management of surgical menopause.

Adult↗
PubMed1995

Menses cup evaluation study.

OBJECTIVE: To determine whether the menses cup is well tolerated by menstruating women. DESIGN: Prospective descriptive clinical study. SETTING: Normal human volunteers in an academic research environment. PARTICIPANTS: Fifty-one menstruating women recruited between June to December 1991. INTERVENTIONS: Each participant was provided with two menses cups and an instruction sheet. Baseline information, including age, occupation, martial status, parity, description of menstrual flow, and current method used to cope with menstrual flow was collected. Subjects were asked to describe their experience with the cup at 1-, 2-, 6-, and 12-month intervals. MAIN OUTCOME MEASURE: The proportion of women who found the cup acceptable. RESULTS: The cup was used by 51 subjects for a total of 159 cycles. Overall, 23 women (45%) found the cup an acceptable method for coping with menses. Among 29 (57%) women who used the cup for two or more cycles, 62% found it acceptable. CONCLUSION: The menses cup may be an acceptable method for some women for coping with menstrual flow.

Equipment and Supplies↗
PubMed1990

Lead exposure among mothers and their newborns in Toronto.

Recent studies have suggested that a fetal blood lead level of 0.48 mumol/L (much lower than 1.21 mumol/L, which is the level previously believed to be toxic to the developing brain) may impair brain development permanently. We measured the maternal and umbilical cord blood levels of lead and free erythrocyte protoporphyrin (FEP) among 95 consecutive mother-infant pairs to determine whether neonates in Toronto are in the high-risk group. There was a significant correlation between the maternal and the cord blood lead levels (r = 0.59, p less than 0.0001). Most (99%) of the infants had cord blood lead levels below 0.34 mumol/L; in 11 cases the levels were below the detection limit of 0.01 mumol/L. The cord blood FEP levels were higher than the maternal levels. The US Centers for Disease Control, Atlanta, currently finds acceptable a blood FEP level of 0.62 mumol/L among children up to 10 years of age; however, this is not applicable to newborns since their higher FEP levels apparently reflect immature heme synthesis and increased erythrocyte volume rather than lead poisoning. Our data suggest that living in Toronto does not impose increased teratogenic risk from intrauterine exposure to lead; however, residents in high-risk areas should be followed up.

Adult↗
PubMed1988

Transabdominal chorionic villus sampling in the second trimester.

Transabdominal chorionic villus sampling under ultrasound guidance was carried out in 19 patients in the second trimester. We found that needle size combination 17/19 provided the best results with consistently adequate samples of tissue. Transabdominal chorionic villus sampling is a potentially useful technique for providing relatively rapid prenatal genetic diagnosis in patients at high risk in the second trimester.

Biopsy↗
PubMed1988

Dantrolene in pregnancy: lack of adverse effects on the fetus and newborn infant.

Twenty malignant hyperthermia-susceptible pregnant patients were given dantrolene sodium orally for 5 days before delivery and 3 days after delivery. When cesarean section was necessary, triggering agents were avoided. No patient had a malignant hyperthermia reaction. No adverse effect of dantrolene sodium was detected by extensive testing of the fetus and neonate. The maternal predelivery dantrolene level was correlated with the noenatal cord blood dantrolene level (r = 0.837). The mean maternal predelivery dantrolene level was 0.99 +/- 0.5 microgram/ml, and the mean neonatal cord blood dantrolene level 0.68 +/- 0.3 microgram/ml. The time from the last dose of dantrolene to delivery was correlated with both the maternal dantrolene level and the neonatal cord blood level (r = 0.65). The half-life of dantrolene in the neonatal circulation was 20 hours. The controversy of oral dantrolene prophylaxis and the implications of this study with regard to further investigation are discussed.

Administration, Oral↗
PubMed1988

Anxiety reduction after chorionic villus sampling and genetic amniocentesis.

This study compares anxiety levels in women undergoing prenatal testing by means of chorionic villus sampling versus genetic amniocentesis. Chorionic villus sampling can be performed earlier in a pregnancy (8 to 12 weeks' gestation) but has a higher risk of miscarriage. Randomized to undergo chorionic villus sampling or genetic amniocentesis as part of a trial examining the safety and accuracy of these procedures, the women were studied at four time periods: time 1, before prenatal testing (9 to 12 weeks' gestation); time 2, after the chorionic villus sampling results were received (13 weeks); time 3, before the genetic amniocentesis results were known (18 weeks), and time 4, after all results were known (22 weeks). Although they were still at risk for miscarriage, members of the chorionic villus sampling group showed a sharp drop in anxiety levels immediately after receiving their results. The genetic amniocentesis group remained anxious until the last test time. In summary, prenatal testing by means of chorionic villus sampling resulted in earlier and sustained anxiety reduction.

Adult↗
PubMed1988

Influence of prolonged pregnancy on infant development.

Although prolonged pregnancy has been associated with a twofold to sevenfold increase in perinatal morbidity and mortality, few investigators have addressed the question of long-term outcome for postterm infants. The existing information, spanning several decades, is confounded by several factors, such as different treatment eras, different population demographics, limited predictive value of testing preschool children, absence of term controls, retrospective nature of many surveys and unreliable criteria used to define prolonged pregnancy. At the University of Toronto a prospective, controlled study to determine the extent and frequency (if any) of developmental disturbances associated with prolonged pregnancy in both eutrophic and dysmature neonates is nearing completion. The results obtained could be important when one is faced with a decision on how to manage a postterm pregnancy.

Child Development↗
PubMed1987

Congenital heart disease in pregnancy: short- and long-term implications.

One hundred forty-four pregnancies that occurred in 74 patients with congenital heart disease at the Toronto General Hospital between 1975 and 1986 were reviewed. The patients were divided into two groups, those with acyanotic lesions and those with cyanotic lesions. Maternal and fetal outcomes in these two groups were compared. Patients with cyanotic lesions developed significantly more congestive heart failure and deteriorated more often in functional cardiac status than those with acyanotic lesions (p less than 0.005). Women with obstructive lesions had a higher incidence of pregnancy-induced hypertension than our general population (p less than 0.005). There was one maternal death in the puerperium in a woman with Eisenmenger's syndrome. Preterm births were more frequent in the cyanotic group (p less than 0.01) as were small for gestational age infants (p less than 0.005). In the cyanotic group the mean birth weight was 900 gm less than that in the acyanotic group (p less than 0.005). The major benefits of corrective cardiac surgery were in the cyanotic group and consisted of fewer spontaneous abortions (p less than 0.01) and small for gestational age infants (p less than 0.02) and more term births (p less than 0.01). Long-term follow-up revealed that 19.2% of women with acyanotic lesions had significant cardiac developments, compared with 90% in the cyanotic group (p less than 0.005). One of 87 infants (1.1%) had congenital heart disease and two had Marfan's syndrome.

Female↗
PubMed1987

Shoulder dystocia: predictors and outcome. A five-year review.

Shoulder dystocia is an uncommon complication of delivery with a high morbidity rate. Ninety-one cases were coded for shoulder dystocia at the Toronto General Hospital from 1980 through 1985. True shoulder dystocia was found in 24 cases, an incidence of 0.23%. There was no significant difference in average weight and percentage of macrosomia between cases of true shoulder dystocia and those merely coded as such. True shoulder dystocia was associated with a neonatal morbidity rate of 42%, consisting of a respiratory arrest and neurological and orthopedic damage. Fundal pressure, in the absence of other maneuvers, resulted in a 77% complication rate and was strongly associated with orthopedic and neurologic damage. Delivery of the posterior shoulder and the corkscrew maneuver were associated with good fetal outcome.

Delivery, Obstetric↗
PubMed1986

Quantitative two-dimensional echocardiographic assessment of fetal cardiac growth.

High-resolution, real-time cardiac imaging and Doppler measurements of blood flow have the potential of extending the fetal cardiovascular profile beyond heart rate monitoring alone. The development of normal standards is a prerequisite to the application of these capabilities. To quantify fetal cardiac growth and explore the potential applications, we performed real-time, two-dimensional echocardiography in a cross-sectional study of 75 normal pregnancies from 17 to 40 weeks gestation. Left and right ventricular, left and right atrial, and aortic root measurements were obtained. Regression analysis showed that the best correlation for ventricular and aortic dimensions with gestational age or biparietal diameter was a straight line (y = mx + b). Ten normal fetuses were then serially monitored. Cardiac dimensions fell within the confidence range of the regression models, and most cases exhibited similar growth slopes. Finally, five abnormal cases were studied to demonstrate the use of these data in diagnosing altered cardiac structure and function.

Cardiomegaly↗
PubMed1986

The influence of prolonged pregnancy on infant development at one and two years of age: a prospective controlled study.

Isolated reports of developmental disturbances following prolonged pregnancy led us to compare, prospectively, at 1 and 2 years of age, infants born after normal term gestations with those born after prolonged pregnancies (exceeding 294 days). The infants were subgrouped according to their physical condition at birth, that is, normal or dysmature (mild or advanced dysmaturity). Infant assessments included: (1) height and weight, (2) hospitalizations, and (3) mental development by the Griffiths Mental Development Scales. Follow-up testing was obtained on 130 term control infants and 89 infants of prolonged pregnancies at 1 year of age and 111 term control infants and 76 infants of prolonged pregnancies at 2 years of age. At 1 and 2 years the general intelligence quotient, physical milestones, and intercurrent illnesses for normal infants and those of prolonged pregnancies were not significantly different.

Body Height↗
PubMed1985

The variability of fetal breathing movements in normal human fetuses at term.

With the use of a B-scan phase-locked tracking system, 108 observations of fetal breathing were performed on 97 normal antenatal patients at term. One hundred thirty-three recorded segments of fetal breathing movements were obtained. Breath-to-breath variability was analyzed in 79 segments and expressed as a coefficient of variability. The mean coefficient of variability was 28.6% +/- 13.2%, and a histogram plot revealed a normal distribution. All fetuses had normal antepartum testing and all Apgar scores and neonatal courses were normal. The potential application of human fetal breathing variability as a test for fetal health is discussed.

Female↗